裂口位于主动脉弓远端Stanford A型主动脉夹层的腔内修复

目的总结腔内修复术治疗裂口位于主动脉弓远端Stanford A型主动脉夹层的临床经验。方法2001年1月至2006年6月在中山大学附属第一医院血管外科通过股动脉入路行主动脉腔内修复术,对21例内膜撕裂口位于主动脉弓远端和近端降主动脉的Stanford A型主动脉夹层进行血管腔内治疗,根据椎动脉造影确定是否重建左锁骨下动脉。结果全组21例中,急性夹层13例,慢性夹层8例,均接受了血管腔内带膜支架修复术,手术成功率100%。17例同时封闭了左锁骨下动脉,其中4例行左锁骨下动脉重建。4例发生内漏,1例术后发生脑梗死。平均随访22.3个月(6~65个月),所有病例均存活。假腔内完全血栓形成12例,部分血栓形成9例。结论主动脉腔内修复术治疗内膜撕裂口位于主动脉弓远端和近端降主动脉的Stanford A型主动脉夹层是有效和安全的,具有微创、成功率高和并发症少等特点。

Endovascular stent graft repair of stanford type A aortic dissection with the tear located the distal end of the aortic arch

Objective To summarize clinic experience about Stanford type A aortic dissection with the tear located the distal end of the aortic arch treated by aortic endovascular repair (EVR) of stent-graft.Methods Elected femoral artery approach,twenty-one patients with the tear in the intima located the distal end of the aortic arch and the proximal end of the descending aorta were performed aortic EVR.And whether the LSA need to be re-established or not by vertebral arteriography would be determined.Results All patients (n=21)of the whole group were undergone EVR of stent-graft successfully,including acute dissection (n=13) and chronic dissection (n=8).Seventeen patients were undergone EVR with closing the LSA and 4 of them were re-established the LSA.4 patients had endoleak and 1 patient had an incident of cerebral infarction after EVR.During the follow up at a mean 22.3 months (range,6-65 months),all patients were survival.CTA showed complete thrombosis of the false lumen occurred in 9 patients and part thrombosis of the false lumen occurred in 12 patients.Conclusion Aortic endovascular stent-graft repair is an effective and safe treatment for Stanford type A aortic dissection with the tear located the distal end of the aortic arch and the proximal end of the descending aorta.This method has minimal invasion,high successful rate and few complications and so on.